Scabies etiology pathogenesis. Scabies - description, symptoms, prevention and treatment of scabies

Etiology and pathogenesis. The causative agent is the scabies mite (sarcoptes scabiei). Infection occurs through direct contact with the patient or through household items (usually underwear and bed linen, clothes), less often in baths. The incubation period lasts mostly 7-10 days, rarely longer. Infection is facilitated by violations of the hygienic content of the skin.

Symptoms. Severe itching appears, aggravated at night when warming in bed, and rashes on the skin of nodules, vesicles, bloody crusts and linear scratches, as well as characteristic itch moves in the form of zigzag lines of a dirty gray color, consisting of black dots. Typical localization of rashes is the flexion surfaces of the upper and lower extremities, the anterior wall of the axillary cavities, the abdomen and lateral surfaces of the trunk, elbows, as well as in men - the skin of the penis, in women - the skin of the mammary glands, in children - palms, soles and buttocks. Scabies moves are localized mainly on the lateral surfaces of the fingers, in the area of ​​the flexor surface of the wrist joints, in the circumference of the nipples in women and on the penis in men.

There are erased scabies farms when the disease is limited to single nodules located not on typical places with mild and absence of typical scabies.

As a result of scratching scabies often complicated by pyoderma.

Differential Diagnosis may be difficult in case of erased forms of the disease, the absence of typical scabies, and when complicated by pyoderma. The presence of severe itching, especially at night, scratching in the nipples in women, buttocks in children, localization of rashes mainly on the flexor surfaces of the limbs help to make a diagnosis. Ticks and their eggs can be found in sections of the stratum corneum of the affected areas. Ticks are also found at the very end of the scabies.

Treatment. Assign Wilkinson's ointment or 33% sulfuric ointment for rubbing into the skin, especially carefully in places of predominant localization of scabies; the ointment is rubbed 1 or 2 times a day (morning and evening) for 5-7 days; on the 6-8th day wash with soap and change clothes. After each rubbing, in order to avoid the development of dermatitis, the skin should be powdered with a mixture of talc and starch in equal parts. In children, 10-15% sulfuric ointment is used.

Treatment according to the Demyanovich method consists in sequentially rubbing into the skin first 60% hyposulfite solution (Natrii hyposulfurosi 120.0; Aq. destill. 80.0. MDS External. Solution No. 1), then 6% hydrochloric acid solution (Ac. hydrochlorici concentrati 12 .0; Aq. desilk 200.0. MDS. External. Solution No. 2).

Having undressed, the patient rubs the solution No. 1 poured into the plate into the skin successively into the right and left hand, torso, right and left legs for 2-3 minutes. After a break of several minutes, a second such cycle of rubbing is carried out. After drying, rub solution No. 2 into the skin in the same order, pouring it into a handful, also 2, and sometimes 3 times within 15-20 minutes.

In cases of severe and widespread scabies, this treatment is repeated the next day. 3 days after the end of rubbing - washing and changing clothes. In young children, a 40% hyposulfite solution and a 4% hydrochloric acid solution should be used. For treatment, you can use Flemings solution (Sol. Vlemings), as well as soap K.

Benzyl benzoate is very effective in the form of a 20% suspension (in children under 3 years old, a 10% suspension is used). The latter consists of 20 g of benzyl benzoate, 2 g of green soap and 78 ml. water. It is rubbed into the whole body, except for the head and soles, 2 times with a 10-minute break to dry. Then the patient puts on clean linen and changes bed linen. This treatment is carried out for 2 days. After 3 days - a shower and a second change of linen.

Prevention. Mandatory examination of all members of the patient's family, all children and attendants in the children's institution, where a patient with scabies was found, all persons in the hostel who were in contact with a patient with scabies; simultaneous treatment of all identified patients. Clothes, bedding are disinfected in appropriate disinfection chambers, linen is boiled. In children's institutions, immediate isolation of patients who are not allowed in the nursery is necessary. Kindergarten, school until cured scabies.

There are also frequent cases of erroneous diagnosis, which is explained by the low level of laboratory tests, improper sampling of material for laboratory testing, unwillingness of medical workers to carry out anti-epidemic measures. In these cases, the symptoms of scabies are intentional or due to lack of practical experience interpreted as allergic dermatitis, neurodermatitis, multiple insect bites, etc.

In these itch passages, which are filled with a secret secreted by the sweat glands, favorable conditions for the existence of mites. Dry passages are inhabited by females that have already lost the ability to fertilize and have ended their functioning. Here they remain until the scabies passage is filled with regenerating epithelial cells.

The moves persist for about 1.5 months and are the main source of infection. In them, the female lays oval eggs, from which the larvae then emerge ( reproductive cycle development). The larva penetrates the skin and hair follicles along the scabies and undergoes molting. Its final transformation through a series of stages of development to a sexually mature male or female (metamorphic cycle of development) occurs mainly in the formed papules and vesicles (vesicles), partly in thin passages and on the skin surface, which is not externally changed.

General epidemiological characteristics of scabies

Healthy people in most cases (95%) are infected directly, that is, directly from patients. How is scabies transmitted? This happens with direct close bodily contact. Half of these cases is sexual contact. Much less often, due to the low resistance of the tick to environmental conditions, infection occurs indirectly, in particular, in the household way. This is especially possible with insufficient observance of the rules of personal hygiene and sanitary regime - in baths, swimming pools, gyms, hostels and hotels, trains, when using common writing and bedding, towels, washcloths, etc.

Despite the fact that this disease is more common in young adults, who are mainly the source of the spread of the pathogen, the main reservoir of infection is people of low social level, without certain occupations and places of residence, and especially the elderly who live in boarding houses for the elderly and the disabled. In the latter case, this is mainly due to insufficient familiarity of the staff of these institutions with what scabies looks like, with a lack of understanding of the importance of proper and high-quality treatment, and a lack of knowledge about how to prevent the spread of infection.

In epidemiology, there is the term "center" of infection, which is understood as the combination of the source of infection (a sick person) and the presence of conditions for the transmission of infection (pathogen). In the presence of one patient, we are talking about a potential focus of infection, two or more patients - about irradiating, or acting. Depending on the grouping of people and the possibility of their contact infection associated with lifestyle, 3 population levels are distinguished:

A significant increase in the incidence of scabies is observed during periods of deterioration in the social well-being of the majority or large limited contingents of the population, local wars, during forced mass migration of people, during natural disasters (floods, earthquakes) and man-made disasters. In addition, alcoholism and drug addiction contribute to the increase in the number of people with social maladaptation, around which foci of infection that cannot be controlled are formed, and the expansion of foci of morbidity.

How scabies manifests itself

Clinical symptoms of scabies and its severity are due to:

After infection with tick larvae, the incubation period averages 14 days, during which they develop to sexually mature individuals. It is practically absent in cases of infection by females, since the latter almost immediately take root, gnaw through passages and lay eggs in them.

Itching

The first signs of scabies are itching and scabies, taking into account their specific localization. Itching can be constant throughout the day. It can be in separate areas or spread to the whole body, excluding the skin of the scalp and face. Most often, its increase is noted in the evening and at night. An important diagnostic factor is the presence of itching in members of the same team or family members.

Often it becomes painful, which leads to sleep disturbances and disorders of the general neuropsychic state of the infected. The degree of itching intensity largely depends on:

• the initial neuropsychic state of the patient;
• the presence of concomitant diseases;
• taking medicines;
• the presence of dyshidrosis, epidermophytosis of the feet and other factors.

By counting the number of scabies, the number of which is 28 on average 2 months after infection, it was found that about 4.5% of female ticks survive until the moment of reproduction. Itching is the main factor that maintains a certain number of ticks in the human body at the level necessary for its survival.

With the constant use of drugs that reduce the severity of itching (desensitizing and antihistamines for outdoor and internal use, ointments and creams containing glucocorticosteroids), which are prescribed by doctors due to diagnostic error or are used by patients as self-treatment, contributes to a rapid pronounced increase in the number of moves (up to 75), and hence an increase in the number of individuals.

Scabies moves

Another specific, most characteristic, early and reliable symptom of scabies. At the same time, their absence in the presence of itching and skin rashes does not rule out the possibility of a disease.

Scabies looks like a straight or curved line about 0.5-0.7 cm long, whitish or grayish-dirty in color, slightly rising above the level of the skin surface. With the development of the reaction of the skin tissue under its walls, cavity elements are formed in the form of individual or chains of vesicles (vesicles) and blisters or papules of a lenticular (disc-like) shape. It depends on the area of ​​localization and is more common in childhood.

Characteristic itch moves

There are several options for scabies. The classification is based on the analysis of scabies, that is, the study of the contents of the moves, and the skin morphological elements that accompany the scabies. The following groups are distinguished:

• skin structure;
• the speed of exfoliation and restoration of epithelial cells;
• skin hygrothermal resistance, that is, its ability to maintain its properties, including strength, under conditions of a certain humidity and temperature.

In accordance with these characteristics, the predominant localization of scabies, which manifests itself in the initial stage of scabies, are areas of the body with the most pronounced thickness of the stratum corneum and minimal hairline. This is the skin in the area of ​​​​the hands (in 96% of patients), the extensor surface in the area elbow joints, skin of the feet and external male genital organs (foreskin, scrotum).

Somewhat later, as the process spreads, the skin between the fingers and on their lateral surface, the anterior surface of the wrist and elbow joints, the anterior and lateral surfaces of the abdomen, the armpits and areola in women are affected.

In these zones, there is a lower skin temperature (by 2-5 °), compared with the rest of the areas. In areas of the body with thinner skin, for example, on the face and back, scabies are much less common - mainly with advanced, long-term disease.

Less constant and less significant symptoms of scabies are manifested by:

• polymorphism of skin rashes in areas not associated with scabies;
• a slight elevation of the itch passage above the skin surface, determined by palpation (Cesari's symptom);
• pustules (vesicles with purulent contents) and pustular crusts on the skin of the extensor surfaces of the elbow joints and around them (Ardy's symptom);
• bloody crusts in the same areas (Gorchakov's symptom);
• superficial pustular rashes and bloody crusts located in the fold between the buttocks and passing to the skin of the sacral zone (Michaelis symptom).

Postscabious lymphoplasia

With a significant spread of the process throughout the body in 50% of patients under scabies on the skin of the trunk, axillary regions, anterior abdominal wall, buttocks and male genital organs, in the area of ​​​​the elbow joints, mammary glands (less often) there is the formation of rashes in the form of papules of a lenticular (disc-shaped) nature, accompanied by excruciating itching, which are called postscabious lymphoplasia.

Postscabious lymphoplasia, which is sometimes distinguished as a separate type of the course of the disease, is associated with a large number of mites and eggs in the passages. The number of the latter increases by almost 2 times. Mortality of embryos and larvae ready to emerge from the egg increases sharply. As a rule, the accumulated excrement and the shells of empty eggs "clog" the clearance of the passages.

Even an adequately conducted full-fledged course of treatment of scabies with anti-scabious agents does little to reverse the development of post-scabious lymphoplasia. The localization zone does not affect the duration of the existence of these papules. At the same time, the duration of their development and resolution is in direct proportion to their number. After the scraping of the scabies, the resolution of the papules occurs relatively quickly.

How to recognize re-infection (reinvasion)?

Re-infection contributes to the occurrence of lymphoplasia in previous places, but without (!) Scabies. This criterion has great importance in cases where differential diagnosis is carried out between primary infection and reinvasion.

Vesicles and papules

Changes in skin areas not associated with scabies are very diverse. Traces of scratching, vesicular and papular elements, bloody crusts appear on them. Immature forms of the tick in the form of larvae or nymphs laboratory research are found on average only in 30% of these papules and vesicles and are their cause. In other cases, the named skin morphological elements arise as a result of a general allergic reaction organism that develops on the waste products of the tick, which are antigens.

Vesicles are characterized by their small size (no more than 3 mm in diameter), the absence of inflammation and isolated location. They are more often found close to the passages in the area of ​​the hands and feet, less often the wrists.

Papules are localized mainly in the area of ​​hair follicles of the skin of the flexor surfaces of the arms, buttocks, anterior and inner thighs, anterolateral surface chest and belly. They are also small - no more than 2 mm in diameter. On the surface of these papules, a small vesicle can often be located.

Types of scabies

There are several main clinical options scabies:

1. Typical.
2. Without scabies.
3. "Incognita".
4. Norwegian.

typical scabies

It is the predominant variant in case of infestation by female ticks after they have been fertilized. As a rule, typical scabies is detected as a result of examination of persons who have been in close contact (usually in bed) with a sick person. It is characterized by all the above skin lesions in the form of severe itching, scratching and blood crusts, as well as symptoms that accompany the life cycle of ticks in the reproductive phase ( different kinds scabies) and in the metamorphic phase, manifested by vesicles and follicular papules localized in characteristic areas.

Scabies without scabies

This species is quite rare, and with an active preventive examination of persons in contact with a sick person. The disease among them develops in case of infection with larvae during a two-week period. incubation period. This period is limited by the duration of the course of the disease without the appearance of scabies. Clinical symptoms are characterized by the absence of passages in the presence of multiple isolated or paired vesicles and papules on the skin of the trunk, on the fingers, mainly on their lateral surfaces, in the folds of the skin between the fingers and on the skin of the buttocks.

Scabies "incognito"

This variant of the disease is also called "clean scabies." It occurs only among people who often take water procedures at home or in connection with the specifics of their profession (workers in shops with hot working conditions and dustiness, athletes, agricultural workers, etc.). The consequence of this is the mechanical removal from the body of most of the individuals of the tick population. Clinically, the disease is similar to typical scabies with minimal symptoms. Single passages are always whitish in color, and most of the papules in the region of the hair follicles are located mainly on the body along the front surface.

Norwegian (crustous, crusty) scabies

It is extremely rare. In modern scientific literature, only 150 patients with this disease are reported. It was first described in patients suffering from leprosy. The background on which the disease usually develops:

• immunodeficiency or immunosuppressive conditions, such as HIV-infected or AIDS patients, long-term treatment cytostatic and hormonal drugs etc.;
• anomalies of keratinization of the epithelium;
• Down's disease, infantilism, senile dementia;
• blood diseases;
• autoimmune connective tissue diseases (dermatomyositis, systemic lupus erythematosus, rheumatoid arthritis, scleroderma, etc.) and systemic vasculitis;
• damage to the central nervous system, accompanied by a disorder of sensitivity in: syringomyelia, syphilitic damage to the nervous system (tasca dorsalis), paralysis resulting from a violation cerebral circulation or trauma to the head or spinal cord and etc.;
• long-term use of desensitizing and glucocorticosteroid drugs, which were prescribed due to an error in the diagnosis of scabies.

The main clinical symptoms of Norwegian scabies:

1. The presence of a very large number of scabies in the skin of the hands and feet.
2. Pronounced hyperkeratosis on the palms and soles, thickening and deformation of the nail plates.
3. The predominance of massive, from a few millimeters to 20-30 mm thick, significant sizes of multi-layered crusts of a dirty yellow or brownish-black color. In some parts of the body, these formations resemble a continuous horny shell, which leads to pain during movements and their limitation. After their removal, an extensive weeping surface is exposed. In a laboratory study, many mites are found under the crusts and between their layers.
4. Polymorphic rash in the form of vesicles, papules, pustules and erythroderma (common reddish spots with coarse peeling).
5. Areas of suppuration of the skin arising from the addition of a secondary infection (secondary). The result of this is an increase in multiple peripheral lymph nodes (polyadenopathy), an increase in body temperature.
6. Unpleasant smell of fermented dough from the patient.
7. Dry brittle ash-gray hair, increased hair loss (alopecia).

People with Norwegian scabies are highly contagious. Around them, limited epidemic foci with a typical form of the disease are often formed.

Learn more about crusty scabies at.

Scabies during pregnancy and nervous scabies

In some articles, the term "scabies during pregnancy" is found. It is not a separate form of the disease and is characterized by the same symptoms. The term is used to draw attention to the possibility of a deterioration in the mental state of a pregnant woman. In this regard (in the absence of treatment), it is possible to develop complications of pregnancy in the form of preeclampsia, infection of the newborn with scabies or secondary pyogenic infection. In addition, during pregnancy, it is necessary to choose a remedy for scabies that does not have a toxic effect on the fetus.

Sometimes this term is incorrectly called "itch of pregnant", which refers to toxicosis early dates pregnancy and has nothing to do with the disease considered in the article.

This also applies to the term “nervous scabies” used in everyday life, which is associated with a distorted perception of the central nervous system normal impulses coming from the skin. "Nervous scabies" occurs mainly among people with an unstable psyche, sleep disturbance, as well as in people who experience neuropsychic stress, stress, etc. for a long time.

Complications of the disease

Quite often, complications can hide the true symptoms of scabies. The most common consequences are:

The diagnosis of scabies is based on:

• anamnesis (history) of the disease, which allows to establish its prescription, the nature of the onset, the alleged cause of itching and its cyclicity, self-treatment attempts and their results, etc .;
• epidemiological data - the presence of a focus of infection, contact with the sick and healthy, place of residence and living conditions, social status of the patient, etc.;
• patient complaints and visual examination;
• dermatoscopy (if necessary) and laboratory tests.

In doubtful cases, an ointment for scabies can be applied once as a trial treatment, a week after which the symptoms of the disease disappear or its severity decreases significantly.

The main diagnostic criteria are:

• characteristic skin itching;
• scabies;
• typical localization of the rash;
• additional characteristic symptoms - Michaelis, Ardi and others;
• lack of effect from the use of antihistamines, anti-inflammatory and desensitizing drugs and external agents based on corticosteroids.

Epidemiological and clinical data should be confirmed by laboratory detection of the pathogen. For these purposes, use:

• a method for extracting a tick using dermatoscopy and its microscopic examination;
• a thin section technique that allows you to see under a microscope not only a tick, but also its excrement, shells, eggs;
• the method of microscopic detection of the pathogen in scrapings of the epidermis in the area of ​​scabies (papule, crust, vesicle, course, etc.) after special treatment of the skin in these areas.

How to treat scabies

Treatment in a hospital is carried out when the patient lives in hostels, hotels, military barracks, boarding schools, etc., when there are no conditions for his isolation. AT stationary conditions it is also necessary to treat patients with various diseases, in connection with which they are not able to serve themselves. In other cases, scabies is treated at home (on an outpatient basis) in accordance with the prescriptions of a dermatologist and under his supervision.

The question of how to treat is decided depending on the duration of the disease and the severity clinical signs, the results of self-treatment attempts, drug intolerance and allergic status, age and the presence of concomitant somatic and other pathologies, the presence of pregnancy and lactation. Each medicine has its own advantages and disadvantages. For the purpose of treatment, the use of one of four drugs is allowed:

1. Sulfuric ointment.
2. Benzyl benzoate.
3. Medifox (permethrin).
4. Spregal.

Algorithm for the treatment of scabies with sulfuric ointment (33%)

• On the 1st day after washing with soap in the shower with the maximum possible steaming of the skin, the latter must be thoroughly dried with a towel. After that, the ointment is rubbed into the skin in the following sequence: arms, torso, legs, including fingers and plantar surface. Hand washing is not recommended for 3 hours after treatment. In the future, after each washing of the hands, the ointment is rubbed;
• Change of underwear and bed linen;
• Once a day, daily from the 2nd to the 5th day, the ointment is rubbed in the same sequence;
• On the sixth day, the remnants of the ointment are washed off in the shower using soap, and underwear and bed linen are changed.

The disadvantages of sulfuric ointment are the duration of the course of treatment, unpleasant odor, soiling of clothing, poor tolerance in hot weather and, most importantly, the high incidence of contact allergic dermatitis, as well as the undesirability of use during pregnancy and lactation.

Medifox (5% emulsion)

• On the first day, 8.0 ml of the drug is diluted in 100.0 ml of boiled water at room temperature.
• After washing in the same order as in the previous case, the emulsion is rubbed into the skin, bed linen and underwear are changed.
• On the 2nd and 3rd day, the rubbing is repeated once.
• On the 4th day, the remnants of Medifox are washed off and linen is changed.

The disadvantages of this treatment are: inconvenient for use form of release (the need to prepare a solution), the inability to use during pregnancy and lactation, increased skin itching after the first rubbing of the drug, the development of resistance to it of the scabies pathogen.

Treatment with benzyl benzoate (20% emulsion)

As well as treatment with sulfuric ointment, it provides for preliminary washing with steaming of the skin, after which:

• On the 1st day, the emulsion in the amount of 200 ml is rubbed in the same sequence and in compliance with the same rules;
• In the next 2 days, washing, applying the emulsion and changing clothes are not carried out;
• On the evening of the 4th day, it is also necessary to wash, rub in the emulsion and change clothes;
• 5th day - the remnants of benzyl bezoate are washed off with soap, but without rubbing the skin, and the linen is changed again.

The disadvantages of benzyl benzoate are the burning of the skin and discomfort during the first application of the drug, as well as its high cost.

Spregal (spray)

Treatment of scabies with this remedy is usually carried out once. After preliminary washing in the same algorithm, the spray is applied to the skin from a distance of 20-30 cm from their surface, except for the head and face, after which it is necessary to change bed and underwear. The next day, in the evening, a shower is taken and linen is changed.

Disadvantages - the possibility of a negative reaction when hit in the upper Airways during the spraying of the drug and its relatively high cost.

During pregnancy and lactation, the drugs of choice are only Benzyl Benzoate and Spregal.

In addition to specific drugs, antihistamines, antiallergic drugs, as well as ointments and creams with glucocorticosteroids are prescribed.

Prevention

Prevention consists of two links. The first of these consists in examining people visiting medical institutions, regardless of the profile of the latter, as well as people entering preschool, school and higher educational institutions, military service and in examining existing teams.

The second link in preventive work is the identification and elimination of foci of the disease. If an infected person is identified, family members, sexual partners and contact persons in places of joint residence (hostel, hotel, etc.) are subject to mandatory prophylactic treatment simultaneously with the patient. Observation of persons of one organized group who have passed preventive treatment. It is carried out three times - upon detection of the patient, immediately and 2 weeks after treatment. If preventive therapy was not carried out, the examination is carried out 3 times at 10-day intervals.

Of great importance is the ongoing disinfection in the focus of the disease, disinfection of underwear and bed linen, towels by boiling for 5 minutes in water with washing powder or in a 1-2% soda solution. Outerwear should be ironed with a hot iron from the front and back sides.

Soft things that cannot be subjected to hot processing must be hung out in the open air for 3 days. Shoes and children's toys are excluded from use for 3 days and also hung out in the air or stored in hermetically sealed plastic bags.

The premises are wet cleaned with a soapy solution or with the addition of disinfectants. At home, bedding such as mattresses, blankets and pillows should be placed in a well-ventilated area for a week. AT medical institutions things are processed in disinfection chambers.

Of great preventive importance is the conduct by medical personnel of sanitary-educational work among collectives.

clinical picture. The main symptom of scabies is widespread nocturnal itching due to the activity of mites at this time of day. In addition to scratching, there are small papulovesicles and pathognomonic for the disease "scabies" in the form of small grayish, slightly elevated, straight or curved stripes with a vesicle at the end, in which the female is located. Favorite localization are areas with thin delicate skin (interdigital folds of the hands, axillary cavities, wrist folds, abdomen, penis, inner thighs, mammary glands). The skin of the face and scalp is not affected. Scabies is often complicated by pyoderma (boils, ecthymas, impetigo).

Diagnosis is based on typical symptoms, detection of scabies, detection of scabies mite in a laboratory study.

Drug therapy

Drugs of choice:

Permethrin (nittifor). Wipe thoroughly hairy part heads with an undiluted preparation, wait until the hair dries (do not wipe or wash). After 2-3 weeks, the hair is washed, dried and, if necessary, treated again.

– Shampoo Reed is applied to the affected areas for 10 minutes, then washed with soap or regular shampoo. Hair treatment is carried out for 10 days.

– Shampoo Anti-Bit. The hair is moistened with water, the preparation is applied and rubbed into the hair roots for 3 minutes, then washed and the procedure is repeated. Conduct a second course - just for 2 days.

– Ithaca. The lotion is applied to wet hair, rubbed in, then thoroughly washed off, applied again, wait 5 minutes, then the hair is thoroughly washed and combed out with a fine comb. The next day, the procedure is repeated. The aerosol is sprayed over the scalp 20-30 times, wait 30 minutes, then rinse thoroughly and comb out with a fine comb; the next day the procedure is repeated.

Precaution: drugs that kill lice are never used to treat eyelash lesions. Lice from eyelashes and eyebrows are usually removed with tweezers. On eyelashes, lice can be killed or weakened with plain petroleum jelly.

Current and forecast. With adequate treatment, over 90% of patients are cured. Relapses are often noted with re-infection and an incomplete course of treatment. Prevention - compliance with the rules of personal hygiene.

15. Dermatomycosis. General characteristics, classification, epidemiology. Conditionally pathogenic and pathogenic fungi. Malasseziosis (keratomycosis) - pityriasis versicolor, trichosporia. Clinic, diagnosis, treatment. Mycosis of the feet and hands. Clinic, diagnostics, epidemiology, treatment. Inguinal epidermophytosis. Trichophytosis superficial and infiltrative-suppurative. Epidemiology, clinic, diagnostics, treatment, prevention. Trichophytosis as an occupational disease of livestock breeders. Microsporia. Epidemiology, clinic, diagnostics, treatment. Favus. Epidemiology, clinic, diagnostics, treatment, prevention. Skin and mucous membrane lesions caused by yeast fungi (candidiasis). Epidemiology, pathogenetic factors. Clinic, diagnosis, prevention, treatment.

Trichophytosis (ringworm) is a fungal disease of the skin, hair and nails. There are superficial (anthroponous) and infiltrative-suppurative trichophytosis.

Superficial trichophytosis is rare, usually in children. The causative agents are anthropophilic trichophytons (T. violaceum, Tr. tonsurans), affecting the stratum corneum of the epidermis and hair (of the "endotrix" type). The source is a sick person. Infection occurs through direct contact or through hats, brushes, combs, underwear and other items. On the scalp appear isolated numerous, up to 1.5 cm in size, foci with irregular outlines and erased borders; the skin is slightly swollen and hyperemic, covered with scales. Many hairs in the foci are broken off at a level of 2-3 mm above the skin surface (“hemp”) or immediately after exiting the follicle (“black dots”); the preserved hair has a normal appearance or the appearance of thin crimped threads "running" under the scales.

On smooth skin there are edematous, sharply defined rounded spots with a sunken, pale yellow, scaly center and a raised, juicy, pink-red peripheral ridge covered with vesicles, nodules, and crusts. The spots are prone to centrifugal growth and merging with each other. Sometimes there is a slight itching. Chronic trichophytosis usually occurs in women and is characterized by numerous "black dots", foci of diffuse peeling and atrophic bald patches on the scalp; extensive erythematous-squamous spots with blurred borders on smooth skin; regular damage to vellus hair; changes in the nails (more often on the hands), which become dirty gray, deformed, "corroded" and sometimes even torn away from the bed.

Infiltrative suppurative trichophytosis. The causative agents are zoophilic trichophytons (Tr. verrucosum, Tr. mentagrophytes var. gypseum), affecting the epidermis, dermis and hair (like "ectothrix"). Sources are sick animals (cattle, especially calves; as well as mice and others), less often a sick person. The disease occurs at any age, more often in adults. It is distinguished by acute inflammatory phenomena (up to suppuration) and a cyclic course ending in complete recovery without a tendency to relapse. The predominant localization is open areas of smooth skin, the scalp, the beard and mustache area. Initially, the disease is almost indistinguishable from superficial trichophytosis of smooth skin. Then, as a result of increasing infiltration, the foci are transformed into juicy plaques and nodes, sharply demarcated from the surrounding skin. The joining suppuration leads to the formation of deep follicular abscesses, at the opening of which liquid pus is released from the gaping hair follicles, especially when pressed. Regional lymphadenitis is possible. The end result is scarring.

The diagnosis of trichophytosis should always be confirmed by microscopy and culture.

Treatment is carried out in a hospital. Inside - griseofulvin, nizoral; local iodine ointment therapy. In chronic trichophytosis, mandatory correction of general deviations; with infiltrative-suppurative trichophytosis, acute inflammatory phenomena are first eliminated. The prognosis is usually favorable.

Prevention. Isolation of sick children. Careful examination of all persons who have been in contact with the patient. Use only individual skin, nail and hair care items. Prevention of infiltrative suppurative trichophytosis is carried out jointly with the veterinary service.

FAVUS (scab) - a fungal disease of the skin, hair and nails, characterized by a long course; practically eliminated in the USSR. Pathogen - Tg. Schonleinii, affects the epidermis (usually the stratum corneum), may penetrate the dermis, possibly hematogenous spread. Contagiousness is low. The source is a sick person. The transmission of mycosis occurs more often in childhood, with close and prolonged family contact. A predisposing factor is the weakening of the body as a result of chronic diseases, various kinds of intoxication, malnutrition and malnutrition. Occurs at any age.

clinical picture. The most typical scutular form. Affected hair becomes thin, dry, dull and as if dusty, but they do not break off and retain their length. A pathognomonic sign is a scutula (scutellum) - a peculiar crust of yellow-gray color with raised edges, which makes it look like a saucer; hair will come out of the center. Skutuli increase in size, merge, forming extensive foci with scalloped contours. They consist of accumulations of fungal elements, epidermal cells and fatty detritus. The "mouse" ("barn") smell emanating from the patients is characteristic. After the skutu falls off, an atrophic surface is exposed, easily gathering into small thin folds like tissue paper. - Sometimes regional lymphadenitis joins.

The squamous form of the favus of the scalp is characterized by diffuse peeling, and the impetiginoid form is characterized by a layering of crusts resembling impetiginous ones. Hair loss and outcome are the same as in scutular favus.

On smooth skin, which is rare and usually associated with head involvement, there are well-demarcated erythematous-squamous, slightly inflamed patches, usually of irregular shape, against which small scutulae may form. A purely scutular form of smooth skin lesions is possible. Cicatricial atrophy does not occur. Known damage to internal organs, leading to death. Diagnosis with scutular form is simple. In other forms, it requires laboratory confirmation.

Treatment is carried out in a hospital; inside-grise-ofulvin, nizoral; locally - iodine-ointment therapy: correction of concomitant diseases, non-specific immunotherapy.

Forecast. Without treatment, the process can proceed indefinitely; with damage to internal organs, usually bad. Prevention. Careful repeated examinations of all members of the patient's family and his environment.

MICROSPORIA - a fungal disease of the skin and hair, mainly children get angry. Distinguish between anthroponous and canthroponous microsporia. Anthroponotic microsporia is very rare in our country. Pathogens - anthropophilic 1crooporums (Microsporon ferrugineum) - affect the horny epidermis and hair; are highly contagious. The source is a sick person. Ways of transmission - direct indirect (through hats, brushes, combs, clothes, toys and other items).

Zooanthroponotic microsporia - frequent mycosis. Pathogens - zoophilic microsporums (in our country M. nis) - affect the stratum corneum and hair; in terms of contagiousness, they are inferior to anthropophilic ones. Sources are cats (especially Gyata), less often dogs. Ways of transmission - direct (main) and indirect (through objects contaminated with hair and scales containing M. canis). Relatively rarely, infection comes from a sick person. Clinical picture. Manifestations of anthroponotic ooantroponous microsporia are the same and similar to trichophytosis, in contrast to which it has ha-sterns: clearer boundaries, rounded outlines, large sizes of lesions on the scalp; taming (usually continuous) hair at the level of 6-8 mm; 1 others around the "stumps" of whitish covers; lack of black dots; on smooth skin - multiple foci; almost constant involvement of vellus hair, frequent enlargement of the neck, occipital and cervical lymph nodes. There are changes in the type of infiltrative-suppurative chophytia.

The diagnosis of microsporia must always be confirmed by legal examinations (microscopy, seeding of affected hair or skin scales). Lucent diagnostics (examination under a Wood's lamp) is important. Treatment is carried out in a hospital. The prognosis is favorable.

Prevention. Isolation of sick children; examination x of those in contact with the patient (including pets) using a Wood's lamp; capture of homeless cats and dogs.

MALASESIOSIS

Pityriasis versicolor (versus versicolor) is a fungal skin disease.

clinical picture. On the skin of the chest, back, neck, less often the shoulder girdle and scalp, small (3-5 mm in diameter) non-inflammatory yellowish-brown spots with clear uneven borders appear, scraping which reveals slight pityriasis peeling. As a result of peripheral growth, the spots increase in size and merge into large foci of the so-called geographical outlines. There are no subjective sensations. A diagnostic iodine test is used, for which the affected skin is smeared with iodine tincture and immediately wiped with alcohol: the stratum corneum loosened by the fungus quickly absorbs iodine and the spots of pityriasis versicolor stand out sharply, turning dark brown against the background of slightly yellowed unaffected skin. Under the influence of ultraviolet rays (in particular, during sunburn), as a result of peeling, unburned spots remain on the sites of former rashes - pseudoleukoderma.

Diagnosis is based on characteristic clinical symptoms and a positive iodine test. In doubtful cases, microscopic examination of skin flakes is carried out to detect the pathogen. Differential diagnosis is carried out in some cases with syphilitic roseola, which does not peel off, does not merge into solid foci, the iodine test is negative, and serological reactions to syphilis are positive, there may be other manifestations of syphilis. Pseudo-leukoderma must be differentiated from true syphilitic leukoderma, in which small rounded (0.5-1 cm) or marbled hypopigmented spots without clear boundaries are located on the slightly pigmented skin of the posterior-lateral surfaces of the neck, sometimes spreading to the skin of the back; positive serological tests and other signs of syphilis make it possible to distinguish it from pseudoleukoderma.

Treatment. Rubbing liquid Andriasyan (urotropin - 5 g, 8% solution acetic acid- 35 ml, glycerin -10 ml), 2-5% salicylic-resorcinol alcohol, Wilkinson's ointment, 10% sulfuric ointment, mycosolone, processing according to the Demyanovich method (see. Scabies) and other antifungal agents for 3-7 days, after which a general hygienic bath with soap and a washcloth is prescribed. To prevent the recurrence of the disease, it is advisable to treat the entire skin. For cosmetic purposes, ultraviolet irradiation is indicated to eliminate pseudoleukoderma after antifungal treatment.

TRICHOSPORIA (from Greek thríx, genus case trichos - hair and spora - sowing, seed), piedra (from Spanish piedra - stone), a fungal hair disease caused by many varieties of fungi of the genus Trichosporon; belongs to the group of keratomycosis.

It is manifested by the formation of multiple, barely noticeable, spindle-shaped hard nodules along the length of the hair, from whitish to dark brown in color, with a peculiar pungent odor; composed of fungal spores. The integrity of the hair is not violated, there are no inflammatory phenomena on the skin. With the American variety of Trichosporia, predominantly women are ill: the hair on the head is affected. The European form of Trichosporia is usually observed in men (in the area of ​​the beard and mustache). The contagiousness of Trichosporia is low: infection is possible through a towel, headdress, comb, etc. shared with the patient. The development of Trichosporium is promoted by washing the head with a decoction of flaxseed and lubricating the hair. burdock oil, which are a nutrient medium for the pathogen.

Treatment: after shaving off the hair, the affected areas are washed with hot water and soap, wiped with a 0.1-0.2% sublimate solution. Prevention: observance of rules of personal hygiene.

CANDIDOZAS

This is a lesion of the mucous membranes, internal organs, nails, due to the exogenous introduction of fungi of the genus Candida. Candida do not form spores and true mycelium. Pseudomycelium consists of closely packed cells. They reproduce by budding and germination. Aerobes. Optimal conditions: t=30-37, pH=7.0-7.4, Sabouraud medium, MPA + glucose, beer wort. Good resistance to drying, freezing and thawing. Are sensitive to action of solution of phenol, formaldehyde, lysol, chloramine, iodites, borates, sulfates, aniline dyes. They live on the surface of the skin and mucous membranes, most of them are not pathogenic.

The source of infection is the patient acute form candidiasis. Infection by direct and indirect contact. Factors contributing to the disease: the virulence of the pathogen, the state of the macroorganism (the integrity of the skin and mucous membranes, skin contamination, the presence of chronic pathology, disorders of the central nervous system, endocrine and other systems), long-term use of antibiotics, cytostatics, glucocorticoids.

Classification:

Surface:

- mucous membranes; - skin; - nail folds and plates;

Chronic granulomatous candidiasis;

Visceral;

Secondary candidiasis;

5. Candidomilides;

CLINICAL FORMS:

Candidiasis of large skin folds- more often in childhood, combined with lesions of the mucous membranes. The skin of the inguinal, femoral, intergluteal, axillary folds is affected. The skin is hyperemic, the boundaries are clear, on the surface there are flabby gray blisters, after they are opened, smooth, shiny, moist erosion surfaces are exposed. At protracted course infiltration increases, deep painful cracks form.

Candidiasis of small skin folds neck, navel, interdigital spaces. Neck - clinical forms easier to treat inflammatory process and infiltration are reduced.

Candidiasis of the toes- erythema with a clear border, accompanied by itching, bubble elements and erosion appear. Wearing shoes exacerbates the process, cracks form. Sometimes the process begins with diaper rash - the lesion is covered with gray-white films, does not reach the back surface.

Interdigital candidal erosion of the hands- the process is asymmetric, more often localized on right hand between 3-4 fingers. Erythema is bright red, exfoliated epithelium along the periphery, pain appears.

Difdiagnosis with herpetic infection. With herpetic infection: - a deeper lesion; - the edges of the lesion are polycyclic; - occurs after hypothermia.

Superficial candidiasis of the trunk skin (in children)- there is no clear clinic, it may resemble a rash with scarlet fever, eczematous erythroderma. The defeat of the palms and feet - against the background of erythema, scaly foci appear in the form of garlands. The skin is yellow-brown, skin folds deepen, hyperkeratosis.

nipple candidiasis- more often in nursing mothers, if the child has thrush. The skin is pink-red to dark red, the skin is flaky with small scales.

Nail damage- starts from the posterior edge of the nail fold, when pressed, liquid pus is released, the luster is lost, destroyed, sharply painful due to edema.

Damage to the skin of the head of the penis and foreskin- in people with diabetes mellitus. Skin - red with tortuous scaly foci, white-gray coating; a shiny eroded surface is exposed, itching develops.

Chronic generalized granulomatous candidiasis- starts at early childhood with damage to the oral mucosa, then the red border, corners of the mouth, nail ridges are involved; the skin in significant areas is erythematous with scaly foci, nodular elements appear, turning into infiltrated plaques, and nodules - into tumor-like formations. Their surface is covered with a gray-yellow crust, after which the vegetation opens.

The defeat of the oral mucosa - candidal stomatitis.

Clinical forms:

1) limited lesion of the tongue - candidal glossitis: the mucous membrane of the tongue is pink-red, longitudinal and transverse stripes appear, the tongue is covered with a white-yellow coating (at first easily, then with difficulty removed with the opening of erosions), atrophy of the papillae.

2) on the mucous membrane of the gums - gingivitis, may be covered with a white coating.

3) tonsil mucosa - candidal tonsillitis, natural color, then foci of white plaque appear, which at first are easily removed.

Thrush- on the affected areas, a white coating resembles milk or semolina.

Candidal cheilitis - the skin of the red border of the lips swells, deep radial folds appear, accompanied by dryness and discomfort.

Damage to the corners of the mouth- candidal seizures - the corners are covered with a gray-white film, after peeling - erosion. The defeat of the mucous membranes of the urogenital tract - vulvovaginitis: - more often in menopause; - for those employed in the production of antibiotics; - with hormonal disorders. Severe itching appears, mucous membranes are bright red, infiltrated, dryness; the areas are shiny, smooth, a gray-white coating appears, liquid discharge with crumbly flakes.

DIAGNOSTICS. Material + 1-2 drops of 10% alkali solution. Microscopically, yeast cells, pseudomycelium, budding cells. There is no natural post-infection immunity.

TREATMENT.

1) prescribing anticandidal antibiotics: nystatin 500,000 IU 6-8 times a day, levorin 500,000 IU 3 times a day, amphoglucomide 200,000 IU 2 times a day, mycoheptin 250,000 IU 2 times a day, course 12-14 days, amphotericin B 0.2- 1 mg/kg every other day i.v. on 5% glucose, nizoral 200 mg 2 times a day for 10-14 days.

2) external therapy:

for skin lesions:

a) alcohol solutions of aniline dyes; b) Castellani liquid; c) ointments: levorin, nystatin, amphotericin, octateonic; d) nitrofungin with water 1: 1; e) clotrimazole (cream, solution);

with mucosal damage:

a) rinsing with 5% solution of drinking soda, furacillin; b) treatment with aqueous solutions of aniline dyes;

c) ointments; d) Decamine cheek tablets every 2 hours; e) 10% borax on glycerin;

with vulvovaginitis:

a) douching with KMnO4, furatsilin; b) ointments containing nystatin, levorin; c) clotrimazole (vaginal tablets). Feature: mainly internal organs, central nervous system, musculoskeletal system are affected. Distributed in the subtropics and tropics.

Contributing factors:

respiratory pathology. ways; - gastrointestinal tract pathology; - hypovitaminosis.

1.coccidioidomycosis- internal organs, bones, skin are affected. Pathogen: coccidioides imitis. Infection occurs by airborne droplets, through damaged skin and mucous membranes of the respiratory tract. After the disease - strong immunity. The incubation period is 1-6 weeks. At first, it proceeds like SARS. X-ray: foci of pneumonia, abscess formation, frequent pulmonary bleeding. After 2-3 weeks, various rashes on the skin. Around large joints in the subcutaneous fat, nodes appear, which then disintegrate, forming ulcers with undermined edges, with a bottom covered with vegetations. After resolution - rough star-shaped scars. With a long course - an increase in ESR, leukocytosis, hypochromic anemia.

DIAGNOSTICS: 1) find spherules; 2) obtaining a pure culture on Sabouraud's medium; 3) obtaining an experimental model (mouse); 4) skin-allergic test (in/to coccidioidin).

TREATMENT: 1) amphotericin B drip intravenously every other day, course - 30 injections; 2) broad spectrum a/b; 3) external therapy; 4) stimulation of healing; 5) iodine preparations; 6) antihistamines.

2. Histoplasmosis (Darling's disease)- damage to the reticuloendothelial system. Pathogen: histoplasma capsulata. Infection is aerogenic, the reservoir of infection is the soil. They begin with damage to the lungs and lymph nodes, every second skin lesion: spots, nodules, nodes, erythematous-scaly foci, connecting into large infiltrates.

DIAGNOSTICS.

1) isolation of the pathogen; 2) obtaining a pure culture; 3) intravenous test with histplasmin.

3. Chromomycosis. Epidemiology has not been studied, burns, congestion, mechanical injuries contribute; localized on the lower extremities, the incubation period is from 3 weeks to several months. At the site of introduction - a pink-red tubercle with a bluish tinge, prone to peripheral growth, numerous tubercles form a single infiltrate. With rejection - an ulcer, heals very slowly, leaves a rough scar.

16. Tuberculous lupus. Scrofuloderma. Warty tuberculosis. Papulo-necrotic tuberculosis. Indurativnaya erythema Bazin. Disseminated miliary lupus of the face. Epidemiology, clinical manifestations. Luposoria. Treatment and prevention.

Tuberculous lupus(lupus vulgaris) is the most common form of skin tuberculosis.

It is characterized by the formation of specific soft tubercles (lupoms) occurring in the dermis, pink in color with clear boundaries with a diameter of 2–3 mm. The main morphological element is a tubercle (lupoma), which is an infectious granuloma. The tubercles are prone to peripheral growth and fusion with the formation of continuous foci (flat shape). With vitropressure (pressure with a glass slide), the color of the tubercle becomes yellowish (the "apple jelly" phenomenon), and when pressing on the tubercle, the bellied probe easily fails, leaving a depression in the tubercle (Pospelov's symptom). Gradually, the tubercles undergo fibrosis with the destruction of collagen and elastic fibers and the formation of cicatricial atrophy. With the exudative nature of the process and under the influence of various injuries, the tubercles can ulcerate (ulcerative form) with the formation of superficial ulcers with soft uneven edges and easily bleeding. Tumor-like, verrucous, mutilating and other forms of tuberculous lupus are also possible. The rash is usually localized on the face, but can also be on the trunk and extremities. The mucous membrane of the nasal cavity, hard and soft palate, lips, and gums are often affected. The disease is more common in women. Lupus vulgaris is characterized by a sluggish, prolonged course and may be complicated by the development of lupus carcinoma.

Scrofuloderma(collicative tuberculosis) - with hematogenous spread of mycobacteria into the skin, the disease is characterized by multiple lesions. When spreading per continuitatem, the process is most often localized in the neck, especially in the triangle under the lower jaw, on the cheeks, near the auricle, in the supraclavicular and subclavian fossae; less often - on the limbs.

Scrofuloderma in children in 80% of cases is caused by Mycobacterium bovine (M. bovis), with which the child becomes infected primarily, as a rule, when drinking infected milk. Sometimes the lungs are the primary focus of tuberculosis.

Scrofuloderma in adults and the elderly occurs due to the hematogenous introduction of mycobacteria into the skin. Lesions in these cases can appear on any part of the body, more often on the neck, chest and abdomen, in the inguinal folds, on the buttocks and tongue. There are usually many lesions.

Clinically, the disease is characterized by the appearance in the subcutaneous adipose tissue of one or more dense, clearly defined nodes, the size of a large pea or hazelnut. Gradually increasing, the nodes can reach the size of a chicken egg, solder with the surface layers of the skin, which turns bluish-red. In the future, the nodes soften and turn into cold abscesses that open with one or more holes, from which a liquid, crumbly pus is released with fragments of necrotic tissue. An increase in the perforation leads to the formation of ulcers with thinned, soft, overhanging cyanotic edges and an uneven bottom with sluggish yellowish, easily bleeding granulations. Ulcers heal slowly, leaving behind uneven scars with bridges, warty and keloid protrusions. With secondary scrofuloderma associated with lymph nodes, ulcers are deeper, penetrating into the tissue of the lymph node. After healing, a retracted, dense, uneven scar also remains. In some cases, scrofulodermal ulcers tend to grow peripherally and can reach a very large size.

Scrofuloderma is often combined with lesions of the bones and joints, as well as with active, but benign pulmonary tuberculosis, sometimes with other forms of skin tuberculosis (lupus, warty tuberculosis). Tuberculin reactions are usually positive.

The course of scrofuloderma is different; in some cases, the disease is limited to the formation of a single node and relatively quickly ends with recovery, in others, due to the appearance of new nodes, it can be delayed for months.

Differential diagnosis should be carried out with syphilitic gums, venereal lymphogranuloma, actinomycosis and deep mycoses.

Warty tuberculosis skin, as a rule, occurs as a result of exogenous infection in people in contact with the corpses of animals or people with tuberculosis (pathologists, medical workers, butchers, etc.); sometimes the disease occurs due to autoinoculation. Lesions are localized mainly on the back of the hands and fingers, less often on the feet. They can be single or multiple.

At the site of the introduction of the pathogen, a dense, painless, bluish-red papule appears on the skin, less often a pea-sized papulo-pustule (“cadaveric tubercle”). The papule gradually grows and turns into a dense, flat plaque, on the surface of which, starting from the center, warty growths and massive horny layers are formed, as a result of which the surface of the plaque becomes uneven, rough. Only on the periphery remains a purple-red border, not covered with horny layers. Sometimes new papules and plaques form near the main focus, gradually merging.

The process progresses very slowly (for years). Gradually, cicatricial atrophy forms in the center of the lesion, sometimes the lesion becomes ring-shaped or even serpiginous. The tubercles characteristic of lupus vulgaris do not develop, the symptom of "apple jelly" is negative. There are no subjective sensations. Sometimes warty tuberculosis of the skin is complicated by lymphadenitis.

The cause of verrucous tuberculosis of the skin in animals is M. bovis. The disease is usually occupational and is observed in slaughterhouse workers (“slaughter tubercle”), butchers, farmers, veterinarians. The skin lesion is localized, with marked hyperkeratosis on the surface of the lesion; the course of the disease is long.

Tubercular tuberculosis of the skin, caused by M. tuberculosis, is usually observed in medical workers who become infected during the autopsy of the corpses of patients (“cadaveric tubercle”, “postmortem tubercle”, “verruca necrogenica”). The lesion on the skin develops rapidly, is characterized by the severity of the inflammatory reaction and the rapid formation of a warty infiltrate. The skin process is often complicated by regional lymphadenitis; sometimes lymph nodes undergo caseous necrosis.

Warty tuberculosis of the skin should be differentiated from warts vulgaris, verrucous lupus vulgaris, bromoderma, pyoderma vegetans, keratoacanthoma, cancer, and blastomycosis.

Papulo-necrotic Tuberculosis occurs by the hematogenous route in young people with tuberculosis, more often girls. On the extensor surface of the limbs, on the buttocks, small nodules appear with necrosis in the center, which leave behind a depressed scar. Nodules pour out jerkily, in attacks, as a result of which you can simultaneously see rashes on different stages development.

Tuberculosis induria (Bazin's erythema induratus) is a hematogenous tuberculosis farm that more often affects young women. Localization - flexion surfaces of the legs. Deeply located nodes emanating from subcutaneous tissue, covered with purple-cyanotic skin, often located symmetrically. Opening, the nodes form sluggish, long-term non-healing ulcers.

The disease is somewhat more common in the autumn-winter period, although patients are recorded throughout the year. The incubation period lasts from 7-10 days_to_1 month and longer. Infection occurs through direct contact with the patient, when using his bedding or underwear, being in the same bed. Among children, the infection can be transmitted through toys if they have previously been used by a sick child.

Clinic

At the site of penetration of the tick into the skin, a small bubble appears. However, the main symptom of scabies is severe itching, especially sharp in the evening and at night, after the patient goes to bed. In addition to the characteristic itching, which is often the first sign of the disease, the appearance of paired and scattered dotted nodular-bubble rashes, scabies (dashed dotted lines of a grayish color), abrasions from scratching the skin are noted. The favorite localization of scabies is the interdigital folds of the hands, the lateral surfaces of the fingers, the flexor surface of the wrist joints, the extensor surface of the forearms, the elbow joint, the anterolateral surfaces of the trunk, the area of ​​​​the anterior walls of the armpits, the mammary glands (nipple circumference), the abdomen, especially in the umbilical ring, buttocks , thighs, shins and penis area. Sometimes on the extensor surface of the elbow joints, dry crusts, scales (Gorchakov-Ardy symptom) can be found that cover the papulovesicular elements. Scabies moves especially often can be found in the area of ​​the wrist joints and in the interdigital folds of the hands. Their length is from 2-3 mm to 0.5 cm. If we consider the scabies passage through a magnifying glass, we can see that it consists of closely spaced black dots - holes that the tick breaks to later exit to the surface of young ticks and for air to enter. place bubbles are formed bloody crusts the size of a pinhead.

The above places of the favorite localization of scabies are explained by the fact that the scabies mite prefers to be located in areas with a thin stratum corneum. In young children, a slightly different localization of scabies is noted: it affects the inner edges of the feet, soles, palms, buttocks, face and scalp.

Severe itching that accompanies scabies comes to scratching excoriations, where patients often bring in pyococcal infection, as a result of which scabies is complicated by folliculitis, boils, lymphadenitis, lymphangitis, impetigo, ecthymas.

The latter circumstance often changes the clinical picture of scabies and greatly complicates the diagnosis (the nature of the itching and the localization of the process help to establish the correct diagnosis). With widespread and complicated scabies, eosinophilia in the blood and sometimes albuminuria in the urine are found. Scabies can get worse and microbial eczema(in women, mainly in the circumference of the nipples, in men - on the inner surface of the thighs). In these cases, the lesions have sharp boundaries, sometimes get wet, covered with a large number of pustules, crusts.

Recently, erased forms of scabies (scabies discreta) have been observed more often, in which there are no characteristic rashes (in particular, scabies), but there is severe itching. This form of scabies is observed in clean people or with improper treatment. With a thorough examination of patients in these cases, it is possible to detect single, paired papulovesicles, nodules, tiny vesicles, urticoid elements.

"Epidemiology, diagnostics, clinic, treatment
and prevention of scabies

(approved by the Main Directorate of Treatment and Preventive Care
USSR Ministry of Health of February 5, 1985 No. 10/11-11)

Epidemiology

Scabies is a contagious skin disease caused by scabies mites. The latter are divided into 3 groups: pruritus, dermatitis and skin beetles. In humans, there is an itch form of scabies, in animals - itching, cutaneous, skin-eating and mixed. The causative agent of scabies in humans is Sarcoptes scabiei varietas hominis (synonyms Sarcoptes hominis, Acarus siro).

Scabies mites are oval tortoise-shaped and are an example of a single-bodied animal. The dimensions of the female are 0.3 - 0.4 mm in length and 0.25 - 0.38 mm in width. The male is smaller than the female, its dimensions are respectively 0.18 - 0.27 and 0.15 - 0.2 mm. The mouth appendages of the tick protrude somewhat anteriorly, on the sides there are two pairs of front legs equipped with suction cups. Two pairs of hind legs are located on the ventral surface and are provided in females with long setae, while the male has suckers instead of setae on the 4th pair of legs.

The clinical picture of the disease is mainly determined by females, since males, having fertilized the latter on the skin of the "owner", themselves soon die. Life cycle scabies mite consists of two periods: reproductive (from egg to larva) and metamorphic (from larva to young female or male). The reproductive period is carried out in scabies. The larvae emerge through the roof of the passage and penetrate into the mouths of the hair follicles and under the scales of the stratum corneum of the epidermis. The metamorphic part of the cycle corresponds to the appearance on the patient's skin of small follicular papules, isolated vesicles and barely noticeable thin passages.

The life span of a tick extracted from the scabies course is, under the best conditions for it (temperature 12 - 14.5 °, humidity 90%), 14 days, but for the most part it does not exceed 5 days. At a temperature of 60 ° mites die within an hour. Ticks and larvae die almost immediately when boiled and ironed with a hot iron and at temperatures below zero outside the "host" body. A strong acaricidal effect is exerted by 3% carbolic acid, creolin, xylene, some essential oils, as well as sulfur dioxide, which kills ticks in 2 - 3 minutes. Tick ​​eggs are more resistant to various acaricides.

The main route of spread of the disease is family contact. Infection with scabies occurs as a result of the transfer of a tick from a sick person to a healthy person, both in direct contact with a person suffering from scabies, and through things and objects that the latter uses. Infection occurs when sexually mature females of the scabies mite get on the skin of a healthy person from clothes, bedding, towels, washcloths, gloves and other household items used by a patient with scabies.

Infection with scabies is favored by close contact with the patient, in particular, a common bed. There are known cases of infection through sexual contact with scabies patients.

In organized children's groups (schools, boarding schools, kindergartens, nurseries), the scabies mite can also be transmitted through writing materials, toys, sports equipment, etc. There are cases of infection in baths, showers, hotels and other public places, provided that the established sanitary regime is not observed.

Contribute to the spread of the disease overcrowding, unsatisfactory sanitary conditions (overcrowding in hostels, lack of hot water, etc.), insufficient hygiene skills of the population (rare change of linen, rare washing, etc.).

The largest number of cases of scabies is recorded in the autumn-winter period and are often detected during mass preventive examinations of the population, especially children.

Despite the systematic increase in the cultural level of the population, the improvement of economic living conditions, there are a number of factors affecting the spread of scabies. These include increased migration of the population associated with the rapid development of tourism, recreation areas, seasonal work, movement a large number people for new buildings, stay on business trips, etc., self-treatment.

It should be noted that in the spread of scabies, a significant role is played by shortcomings in the work medical service, weakening attention to this infection on the part of health authorities, defects in medical examination, etc.

The most important anti-epidemic measures in the fight against scabies are early recognition of the disease; identification, qualitative examination and treatment of all contact persons; timely and complete treatment of patients; proper disinfection of foci of infection.

Clinic

The incubation period for scabies varies from 1 to 6 weeks, with reinfection it is much shorter and amounts to several days, which is due to the sensitization of the body that developed during the initial infection. The duration of the incubation period depends on the number of mites that have fallen on human skin during infection, on the reactivity of the body, and on the patient's hygiene skills.

The main clinical symptoms of scabies are:

1) severe itching, aggravated in the evening and at night; 2) detection of characteristic scabies; 3) the appearance of nodular and vesicular rashes, erosions, scratching, bloody crusts; 4) favorite localization of the elements of the rash.

The first clinical symptom of scabies is itching. It appears after the introduction of the scabies mite into the stratum corneum of the epidermis. Visible manifestations of scabies at this time are absent or are characterized by the appearance of blisters, vesicles at the site of infection. Itching during scabies is felt not only at the site of the introduction of ticks, but is also transmitted reflexively to other areas of the skin, and therefore, limited at first, it intensifies every day and can take on a generalized character. The reason for the sharp increase in itching during scabies at night is seen in the fact that the greatest activity of the female mite falls on specified time days. The intensity of itching ranges from mild to severe.

Most characteristic symptom disease is a scabies course, which the female mite lays in the stratum corneum of the epidermis. A typical scabies course has the appearance of a slightly elevated, straight or curved, whitish or dirty gray line 0.5 - 1.0 cm long. At the anterior (blind) end of the course, a vesicle is only sometimes found, here the female mite is more often visible, translucent through stratum corneum in the form of a dark dot. The described passages are especially well expressed on the lateral surfaces of the fingers, the back, palmar and lateral surfaces of the hands, on the flexor surface of the wrist joint, elbows, ankles, rear of the feet and soles. Often, itch passages are represented by several vesicles at various stages of development, arranged linearly in the form of a chain. Sometimes a single vesicle no less than 0.3 × 0.3 cm in size or a bubble with serous contents is formed under the entire tick passage, then the passage itself lies in their tire. In secondary infection, vesicles and blisters turn into pustules. When the exudate of the abdominal elements dries up, the passages take the form of serous or purulent crusts.

Some patients have old, dry, dilapidated passages resembling a superficial crack with remnants of a typical passage at the beginning or end. Occasionally, the typical ascending line may begin or be interrupted by a vesicle or linear crust. In the event that the vesicle in the posterior part of the passage has opened, a corolla of exfoliated epidermis is formed in its place, connected to the undestroyed part of the passage. Outwardly, such a move along the contour resembles a "racquet". These passages, as a rule, are confined to the folds of the skin on the hands and in the area, the flexor surface of the wrist joint.

Often in adults, on the skin of closed areas of the body (axillary region, anterior and posterior axillary folds, abdomen, buttocks, inner thighs, lower back, inguinal and intergluteal folds, mammary glands in women and genitals in men), passages are observed in the form of a whitish line or linear peeling of the epidermis on the surface of dense papules, bluish-purple in color, 0.5 × 0.5 cm in size or more. Such moves are often also found on the skin of infants and in places of pressure by clothing.

In addition to itch moves clinical manifestations uncomplicated scabies are characterized by the appearance of small nodules, vesicles, erosions, bloody crusts, linear scratches on symmetrical areas of the skin. Typical localization of these rashes: brushes, flexor surface of the upper and lower extremities (especially in the area of ​​the wrist and elbow bends, along the anterior-inner surface of the thighs), torso (mainly in the area of ​​the anterior-lateral surfaces of the chest and abdomen, on the lower back, buttocks, milk glands in women, in the region of the rhomboid fossa and the anterior walls of the armpits), in men - on the genitals. Rashes in adults are usually absent on the face, neck, scalp, in the interscapular region. In children, any part of the skin is involved in the process.

In men, nodular elements can be located on the scrotum and penis, resembling syphilitic papules. The diagnosis of scabies is helped by the patient's complaints of itching mainly at night, the presence of typical scabies and scratching in other areas of the skin, the absence of regional scleroadenitis characteristic of syphilis, and negative serological reactions. However, it is also necessary to remember the possibility of simultaneous infection with two diseases, when the clinical manifestations of syphilis mask the manifestations of scabies and vice versa.

Manifestations of scabies can be localized on the extensor surfaces of the elbow joints in the form of impetiginous rashes and purulent crusts (Ardy's sign) or spot bloody crusts on the elbows or in their circumference (Gorchakov's symptom).

In addition to the typical clinical picture diseases distinguish scabies without moves, which can only conditionally be called asymptomatic (erased), and atypical form diseases. Low-symptom (erased) scabies is much less common, mainly in the early stages of the disease in patients who are actively identified among contact persons and during mass preventive examinations. The duration of the disease usually does not exceed 2 weeks.

Clinical manifestations of oligosymptomatic scabies are characterized by total absence scabies moves. On examination, rashes are revealed in the form of small, follicular papules, isolated vesicles, urticarial elements, erosions, bloody crusts, scratches located on symmetrical areas of the skin of the trunk and extremities. Rashes usually have localization typical for scabies. Itching is moderate or mild.

Sometimes there are lesions of people with a pot-bellied mite, causing the so-called "grain scabies". A pot-bellied mite most often gets on human skin when it comes into contact with grain, when they sleep on straw, in more rare cases with dust infected with a mite. Grain scabies proceeds like a normal urticaria, often with large blisters, bubbles on their surface, which quickly turn into pustules, sometimes somewhat resembling those of chicken pox. There is always a very intense itching. Grain scabies is localized mainly on the skin of the trunk and neck, the face and limbs are rarely affected. Unlike ordinary scabies, the pot-bellied mite does not drill into the skin, but only bites it. Treatment is carried out in the same way as with ordinary scabies.

A rare variety of the disease is the so-called "Norwegian" (crustous) scabies, first described in 1847 by Norwegian scientists Beck and Danielson in patients with leprosy. Later, this form of scabies was noted in people suffering from Down's disease, senile dementia, syringomyelia, beriberi, dementia, in patients with immune deficiency, as well as against the background of long-term hormonal and cytostatic therapy.

This form of the disease is characterized by the appearance of massive yellowish-dirty or brown-black crusts, from a few millimeters to 2–3 cm thick, as well as localization of rashes typical of scabies. At the same time, the skin of the face, neck, and scalp can be affected, and the process takes on a generalized character, sometimes resembling a solid horny shell that limits movement and makes them painful. However, there are cases with localized crusts (skin folds, elbows).

Between the layers of crusts and under them, a large number of scabies mites are found, and on the lower surface of the layers there are sinuous depressions corresponding to scabies. When removing the crusts, extensive, weeping, erosive surfaces are found. The skin of patients with Norwegian scabies is dry, the nails are sharply thickened, hyperkeratosis is expressed in the area of ​​​​the palms and soles. The disease is often accompanied by secondary pyoderma, lymphadenitis, in general analysis blood recorded eosinophilia, leukocytosis, accelerated ESR. With a pronounced clinical picture, itching is weak or absent. This form of scabies is contagious, with infected contacts developing typical scabies.

Sometimes in patients with scabies, post-scabious nodules are observed (post-scabious lymphoplasia of the skin, persistent scabies). The reason for this process is a special predisposition of the skin to respond to some kind of irritant with reactive hyperplasia of the lymphoid tissue. Clinical manifestations of persistent scabies are represented by peculiar nodular elements that occur after or during the underlying disease. The nodules are round or oval in shape, ranging in size from a large pea to a bean, bluish-pink or brownish-red in color, have a smooth surface and a dense texture. The number of loose elements ranges from single to multiple. The most common localization is closed areas of the body (male genitalia, inner thighs, abdomen, armpits, chest area around the nipples). The course of the process is benign, but extremely long. Cases with disease duration from several months to several years are described. Spontaneous regression of nodular elements and their reappearance in the same places are characteristic. Lymphocytosis is often found in the blood. The nodules are usually resistant to local therapy, including anti-scabies. For their treatment, it is recommended to use cryotherapy or the introduction of cortisone derivatives into the base of the nodules.

Severe itching that accompanies scabies leads to scratching, as a result of which scabies is often complicated by a secondary infection (folliculitis, impetigo, ecthyma, boils, carbuncles, lymphadenitis, lymphangitis). The latter circumstance often changes the clinical picture of scabies and greatly complicates the diagnosis (the nocturnal nature of itching and the localization of the process help to establish the correct diagnosis). With common and complicated scabies, eosinophilia, leukocytosis, accelerated ESR, and sometimes albuminuria are found. Scabies can also be complicated by microbial eczema (in women, mainly in the nipples, in men - on the inner surface of the thighs). In these cases, the lesions have sharp boundaries, sometimes get wet, covered with a large number of pustules and crusts. Sometimes from the very beginning of the disease, scabies is accompanied by dermatitis.

Scabies in children

Certain difficulties arise in the diagnosis of scabies in children, when the clinical picture of the disease is masked by pyoderma, eczema, urticaria, pruritus. The course of scabies in children, unlike adults, has its own characteristics: the process is common; rashes are localized on any part of the skin, including the scalp, face, neck, palms and soles; more abundant on the lower extremities (thighs, shins, ankles, inner edges of the feet); there are urticaria elements; exudative phenomena are more pronounced; often the disease is complicated by dermatitis, eczema, pyoderma.

Clinical manifestations of scabies in children of different age groups have their own characteristics.

In the first 6 months of a child's life, the main elements are blisters, vesicles, blisters and itchy burrows. Rashes are localized on any part of the skin, predominantly on the skin of the palms, soles, in the rear of the foot and on its inner arch. The presence of urticoid rashes gives rise to differential diagnosis scabies with pruritus and urticaria.

In infants and young children childhood(up to 3 years) rashes on the face and scalp clinically resemble a picture of acute weeping eczema, which is not amenable to conventional anti-eczematous therapy. And when blisters, edematous papules, vesicles appear, it becomes necessary to carry out differential diagnosis with strofulus. A characteristic feature of the clinical course of scabies in children of early childhood is the absence of rashes in the region of the interdigital folds of the hands, on the lateral surfaces of the fingers and on the anterior edge of the axillary fold. Sometimes in this age group, a pemphigoid form of scabies is observed, characterized by the appearance of large blisters, up to a walnut, with transparent contents and an itch tract in the tire, localized in areas of the skin that are favorite for scabies. Skin itching is pronounced, which leads to sleep disturbance. A rare, but possible, localization of scabies in infants and young children is the defeat of the scabies mite of the nail plates, which thicken, loosen, longitudinal and transverse cracks form on the surface.

In children of preschool and school age, in most cases, the clinical manifestations of scabies are minimal and are characterized by the appearance of single seropapules and bloody crusts. Scabies moves are few or they are poorly expressed.

Diagnostics

The diagnosis of scabies should be based on clinical manifestations, epidemiological data and laboratory results. The search for scabies mite should be carried out in each patient, however, negative results do not yet indicate the absence of scabies in the patient in the presence of a typical clinical picture of the disease and patients among contacts. Mandatory confirmation of scabies by a laboratory method is carried out especially in cases where the diagnosis of the disease is difficult.

There are several methods of laboratory diagnosis of scabies.

The method of extracting the tick with a needle: under the control of a magnifying glass, the needle opens the blind end of the scabies passage at the site of a brownish dotted elevation, then the tip of the needle is advanced in the direction of the scabies passage, making an attempt to bring the tick out, which is attached to the needle with its suction cups and is easily removed. The resulting tick is placed on a glass slide in a drop of 10% sodium hydroxide, covered with a cover slip and microscoped.

Thin section method: with a sharp razor or small scissors, a section of the stratum corneum of the epidermis with an itch or vesicle is cut off and, after treatment with 20% sodium hydroxide for 5 minutes, is examined under a microscope. This method allows you to get not only the tick, but also its eggs, shells, excrement.

The method of scraping pathological material: a drop of glycerin or 20% sodium hydroxide is applied to a glass slide. With a blade, lancet or Volkmann's spoon, a scraping of the scabious element is made without affecting the papillary dermis. The contents are transferred to a glass slide, covered with a coverslip, lightly pressed so that a drop of glycerin or alkali spreads evenly under the coverslip and microscopic after 10 minutes.

The method of sublayer scraping of elements until the appearance of blood: scrapings are made with an eye spoon with pointed edges from 3-4 homogeneous fresh elements until blood appears. The material is placed on a glass slide in a drop of 20% caustic alkali (sodium or potassium) with glycerin in equal volumes, covered with a cover slip and microscoped after 10-20 minutes, and if the results are negative, even 2, 4, 24 hours after preparation of the drug.

The method of "alkaline skin preparation" consists in applying 10% alkali to scabies on the skin. After 2 minutes, the macerated epidermis is scraped off with a scalpel, transferred to a glass slide in a drop of water and examined under a microscope.

Method of laboratory diagnostics using lactic acid*: with a glass rod or an eye spoon, a drop of lactic acid is applied to the eruptive element (scabies, papule, vesicle, crust, etc.). After 5 minutes, the loosened epidermis is scraped off with a sharp eye spoon until blood appears, capturing the area on the border of healthy and affected skin. The resulting material is transferred to a glass slide in a drop of lactic acid, covered with a cover glass and microscoped.

The method is convenient in that lactic acid is used both as a means of loosening the epidermis before scraping and preventing it from crumbling, and as a substance that clarifies and fixes the material for microscopy, and as a drug by which it is possible to remove the remnants of dyes used for staining scabies. .

Lactic acid does not have an irritating effect, and its bactericidal properties prevent the development of pyogenic complications at the sites of scrapings. The method is distinguished by the speed and reliability of the diagnosis of the disease.

In some patients, itch moves are not sufficiently pronounced. In these cases, it is recommended to lubricate the suspicious element with iodine tincture, aniline dyes, ink or 0.1% sodium fluorescenate solution. The loosened layer of the epidermis at the site of the itch move absorbs the coloring matter more intensively, as a result of which it stains more contrast. After lubricating the skin with a 0.1% solution of sodium fluorescenate and under illumination with a fluorescent lamp, the scabies acquire an intense yellowish glow.

If scabies is suspected, it is advisable to conduct a trial treatment with anti-scabies drugs. In the case of a positive effect, the patient is registered as a patient with scabies, appropriate anti-epidemic measures are taken.

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* The method was developed by TsKVI together with the Department of Entomology, Faculty of Biology, Moscow State University.

Treatment

The most widespread in the treatment of patients with scabies were the methods of therapy with benzyl benzoate and Demyanovich, which have high efficiency, good tolerability and speed of action. The methods of choice are the treatment of scabies with sulfuric ointment, Wilkinson's ointment and polysulfide liniment.

Regardless of the method of therapy, it is necessary to treat the entire skin covering, and not just those areas where there are rashes. Rubbing medicines must be carried out in a warm room. In cases where there is no effect from the use of one drug, it is necessary to prescribe another.

The method of treating patients with scabies with benzyl benzoate was approved by the pharmacological committee of the USSR Ministry of Health on December 18, 1968. Benzyl benzoate is a benzyl ester of benzoic acid ( C 14 H 12 O 2) is a light yellow liquid with a pleasant odor, soluble in alcohol and insoluble in water.

Benzyl benzoate is used in the form of a 20% freshly prepared water-soap suspension for all patients, and for children under 3 years of age in the form of a 10% suspension.

Method of preparation: 2 g of green soap, and in its absence, 2 g of crushed laundry soap, dissolve in 78 ml of warm boiled water, add 20 ml of benzyl benzoate and shake. A milky suspension with a slight odor is obtained. Benzyl benzoate, prepared as a suspension, is stored in a dark place at room temperature for no more than 7 days from the date of preparation. Produced in bottles of 100 g.

Method of application: the patient or medical worker conducting rubbing, before starting treatment, washes his hands with warm water and soap. The suspension of benzyl benzoate is thoroughly shaken before use, and then rubbed with hands into the entire skin, except for the head. A 10% suspension used to treat children under 3 years old is recommended to be rubbed lightly into the skin of the scalp and face, but so that the drug does not get into the eyes.

Rubbing benzyl benzoate into the skin should be carried out in a certain sequence: they begin with the simultaneous rubbing of the drug into the skin of both hands, then into the left and right upper limbs, then into the skin of the trunk (chest, abdomen, back, gluteal region and genitals) and, finally, into the skin of the lower extremities up to the toes and soles.

On the first day, two consecutive rubbings are carried out for 10 minutes with a 10-minute break between them to dry the skin. At the end of the procedure, the patient puts on clean underwear and disinfected outerwear. Be sure to change bedding. Treatment should be carried out within 2 days. Hands are additionally processed after each wash. 3 days after the end of treatment, the patient takes a shower and again changes underwear and bedding. In common and complicated forms of the disease, when during the course of treatment the doctor notes the appearance of fresh rashes on the skin, and the patient complains of continued itching in the evening and at night, it is recommended to extend the course of treatment up to 3 days or prescribe a second 2-day course after 3 days after the end of the first.

The above method of treatment is generally accepted.

In connection with the exit from the passages of a large number of larvae to the surface, it is recommended to bathe the patient before each rubbing of the drug. It has been established that all mobile stages of tick development (females, males, nymphs, larvae) and eggs with embryos die after a single rubbing of the drug, but a small part of the larvae in egg shells ready for hatching remains unchanged even after a two-day course. Their hatching contributes to the persistence of the symptoms of the disease in some patients and requires additional treatment. Since the formed larvae leave the eggs after 1.5 - 2.5 days and then become available for the action of the drug, the following treatment method is recommended. The duration of the course is 6 days. A 20% water-soap emulsion of benzyl benzoate in an amount of 100.0 is rubbed once only on the first and fourth days of the course. Be sure to bathe the patient before each rubbing of the drug. During the second and third days of the course, no specific treatment is carried out. These days can be successfully used for the treatment of complications associated with scabies. The change of underwear and bed linen is carried out twice: after the first rubbing of the drug and 2 days after the last, i.e. at the end of the course, when the patient must wash again.

All clothes of the patient must be disinfected (boiling, washing in hot water, ironing, especially from the inside, etc.).

The treatment of scabies according to the Demyanovich method consists in sequentially rubbing into the skin of the trunk and extremities a 60% solution of sodium hyposulfite (solution No. 1) and a 6% solution of concentrated hydrochloric acid (solution No. 2), and in children, the concentration of solutions, respectively, is 40% (No. 1) and 4% (No. 2).

Method of preparation: to prepare a 60% solution of sodium hyposulfite (solution No. 1), 60 g of hyposulfite and 40 ml of water are taken. To speed up the preparation of the hyposulfite solution, the water should be warm. To prepare solution No. 2, 6 ml of pure concentrated hydrochloric acid and 94 ml of water are taken. Solutions are prepared in separate bottles labeled "Solution No. 1 (hyposulfite)" and "Solution No. 2 (hydrochloric acid)". The hydrochloric acid solution should be stored in a bottle with a narrow neck and a ground stopper.

For the treatment of children, a 40% solution of hyposulfite - No. 1 (40 g of hyposulfite and 60 ml of water) and a 4% solution of hydrochloric acid - No. 2 (4 ml of pure concentrated hydrochloric acid and 96 ml of water) are prepared.

How to use: before use, the hyposulfite solution is slightly warmed up and rubbed into the skin with your hands in the following sequence: 1) in the left upper limb, 2) in the right upper limb, 3) in the trunk, 4) in the gluteal region and lower limb on one side, the same on the other side. Rubbing into each area lasts 2 minutes (for all areas 10 minutes). After 10 minutes of drying, a mass of hyposulfite crystals appears on the skin. The second rubbing is performed with the same solution and in the same sequence.

After a repeated 10-minute break, they start rubbing a 6% hydrochloric acid solution into the skin, which is carried out in the same order for one minute for each area 3 times at intervals of 5 minutes for drying. In especially advanced cases, a fourth rubbing of a 6% hydrochloric acid solution can be performed in the same sequence.

Rubbing solutions should be done carefully, without mixing them, especially in places of favorite localization of scabies. Solutions should be taken little by little, pouring as needed into the palm of your hand. Thus, processing by the Demyanovich method takes more than an hour.

At the end of rubbing and after the skin has dried, the patient puts on clean underwear and does not wash for 3 days, but the solutions are rubbed into the hands again after each wash. After 3 days, the patient washes with hot water and changes clothes again. With insufficient effectiveness, the course of treatment is repeated.

When treating children, it is recommended to avoid vigorous rubbing. In infants, instead of rubbing, it is better to wet the skin surface with the indicated solutions, repeating the course of treatment after 3-4 days. Treatment is recommended to be less intensive, but longer.

For the treatment of scabies, you can also use anti-scab ointments containing sulfur: Wilkinson's ointment (liquid tar 15 parts, calcium carbonate 10 parts, purified sulfur 15 parts, naftalan ointment 30 parts, green soap 30 parts, water 4 parts) or 33% sulfuric ointment.

Before starting the ointment treatment, the patient is washed with warm water and soap. Ointments are rubbed daily for 5-7 days, especially in areas of the skin of the favorite localization of the scabies mite (interdigital folds of the hands, the area of ​​the wrist, abdomen, etc.). In areas with more delicate skin (genitals, peripapillary region, inguinal-femoral and other folds), the ointment should be rubbed very carefully to avoid skin irritation. On the 6th or 8th day, the patient washes with soap and changes underwear and bed linen. For the treatment of children, 10-15% sulfuric ointment should be used, Wilkinson's ointment is not recommended.

Treatment of scabies with polysulfide liniment. The active principle of this liniment is sodium polysulfide ( Na 2 S 4), for the preparation of which 600 ml of water are taken, 200 g of pure caustic soda and immediately 200 g of powdered sulfur ("sulfur color") are added and stirred with a glass rod. The resulting solution is clear, yellowish-brown in color. To obtain a polysulfide solution, you can take the above ingredients in other weight quantities, but maintaining the ratio (water: NaOH: sulfur - 3:1:1). The content of polysulfide in the solution is about 27%. The polysulfide solution is usable for up to 1 year when stored in a tightly closed container.

The basis of the liniment is 5% soap gel. To prepare it, take 50 g of crushed soap (preferably "baby"), heat it in 1 liter of water until completely dissolved, then cool it in an open container at room temperature. Polysulfide liniment is used at 5% concentration of the active principle (for children) and 10% (for adults).

The required concentration of liniment is prepared as follows: 10 parts (for 10% concentration) or 5 parts (for 5% concentration) of sodium polysulfide solution and 2 parts of sunflower oil are added to 100 parts of 5% soap gel. These ingredients are not taken in parts by weight, but in milliliters. The mixture is shaken vigorously until a homogeneous yellow mass is obtained.

How to use: the drug is rubbed in children over the entire surface of the skin, and in adults, the exception is the face and scalp, for 10-15 minutes. One rubbing requires 100 ml of liniment. Repeated rubbing is carried out on the second day. The patient does not wash for 3 days from the moment of the first rubbing, and on the 4th day takes a shower or bath, changes underwear and bed linen.

For the treatment of scabies, soap "K" is also used (a mixture in equal volumes of paste "K", i.e. bisethylxanthogen and soap), which is rubbed into the skin in the form of a 5% aqueous emulsion daily for 5 days, on the 7th day the patient washes and changes linen. A freshly prepared emulsion should be used, renewing it at least every two days. When using a more concentrated emulsion, dermatitis may occur.

Treatment of complicated scabies

Methods of treatment of complicated scabies are different depending on the nature of the lesion. Limited pyoderma and slight eczematization do not prevent the use of anti-scabies drugs in combination with drugs aimed at stopping complications. In those cases when scabies is complicated by widespread pyoderma with an abundance of pustules, crusts, extensive eczematization, its treatment is difficult: it is impossible to carry out intensive rubbing, since this may cause dissemination of a pyogenic infection and the treatment of scabies is less effective due to the large thickness of the crusts that prevent the drug from penetrating into epidermis. Here, first of all, measures should be aimed at stopping pustulization, weeping, careful removal of crusts, according to indications, antibiotics, sulfonamides, and locally aniline dyes and disinfectant ointments are prescribed.

With pronounced dermatitis or eczematization associated with scabies, treatment should be carried out that reduces the manifestations of complications (calcium preparations, sodium thiosulfate, dimedrol, suprastin, tavegil, pipolfen, diazolin, etc.).

With dermatitis that occurs during therapy, treatment should be stopped regardless of the method of anti-scabies therapy even before it ends and anti-inflammatory therapy (antihistamines, calcium preparations, topical lotions, shaken mixtures, steroid ointments) should be started. With the attenuation of inflammatory phenomena, the treatment of scabies can be resumed, but to prevent the recurrence of dermatitis, it should be carried out with drugs of a weaker concentration.

The method of treating complicated scabies with polysulfide liniment is the same as for uncomplicated scabies, since the drug does not cause exacerbation of eczema, and has a positive therapeutic effect on the elements of superficial pyoderma.

Extradition question sick leave for patients with scabies, the doctor decides individually in each case, taking into account the nature of the patient's work, living conditions, the effectiveness of treatment, the presence of complications, the prevalence of the process, etc. Patients whose work is associated with contact with the public (children's, food, some communal, medical institutions, etc.) and with business trips are subject to mandatory suspension from work with a sick leave.

Prevention

Doctors of dermatological and venereological dispensaries (departments, offices, and in their absence, doctors who are entrusted with the duty of a dermato-venereologist) carry out early diagnosis of scabies, its registration, identification of sources of infection and all persons who have been in contact with the patient, treatment, dispensary observation for patients and contacts in the focus of the disease. They maintain the closest relationship with the employees of the SES and the disinfection departments to monitor the outbreaks of the disease, the timeliness, completeness and quality of disinfection measures.

Identification of cases of scabies should be carried out in an active way:

a) during the examination of persons who have been in contact with a patient with scabies;

b) monthly during preventive examinations of children's groups (schools, kindergartens, nurseries, pioneer camps, etc.);

c) from August to October inclusive, every 7 days, preventive examinations should be carried out in schools, boarding schools, preschool institutions, mechanization schools, vocational schools;

d) when patients apply to polyclinics, outpatient clinics, medical units, during admission to inpatient treatment in medical institutions of any profile, including children's;

e) during mass preventive examinations of the population, including among the decreed contingent;

f) through medical supervision of the groups living in hostels;

g) in rural areas according to epidemiological indications - during house-to-house rounds.

For each identified patient, the doctor (middle medical worker) fills out a notice in the form 089 / y and sends it to the territorial dermatovenerological dispensary, in rural areas - to the skin cabinet (in its absence, to the central district hospital). At the same time, the doctor (middle medical worker) who identified the patient with scabies sends a copy of the notice to the territorial sanitary and epidemiological station.

When a patient is identified in an organized team (kindergartens, nurseries, schools, boarding schools, hostels, etc.), along with filling out a notice on him in the form 089 / y urgently (by telegram, by phone, courier), the SES is notified in order to immediately carrying out the necessary anti-epidemic measures in the outbreak.

If scabies is found in schoolchildren and children attending kindergartens, nurseries, they should be suspended from attending a school or child care facility for the duration of a full treatment (lack of fresh elements, regression of existing rashes). Only after carrying out the whole complex of therapeutic and preventive measures, confirmed by a certificate from a dermatovenereologist (or a doctor who is entrusted with his duties), children can be allowed back into children's groups.

All information about the source, about family members and other persons living with the patient in the same room or who had household or sexual contact with him is entered in medical card outpatient (formula No. 025 / y) and transferred to district nurses for searching and calling them for examination during the first 3 days.

Treatment of a patient with scabies is carried out by a dermato-venereologist, and in cases where he is not present, by a doctor acting in his capacity. Inpatients in somatic hospitals are treated on the spot, which is reported to the dermato-venereologist.

Patients are sent for treatment in the same linen and clothes in which they were at home. All patients identified in the same focus should be treated simultaneously.

Treatment of patients with scabies, depending on the epidemiological situation, can be carried out on an outpatient basis (in scabiozoria) in cases where the patient has a non-complicated, uncomplicated form of the disease and there are necessary sanitary and living conditions for isolating him from those around him for the duration of treatment and dispensary observation.

Scabiozoria for outpatient treatment of patients with scabies are organized by hospitals or dermatological and venereal dispensaries, medical units and other medical institutions using sanitary checkpoints (with a shower), disinfection chambers available in medical and preventive and sanitary and anti-epidemic institutions.

In the staff of scabiozoria, it is advisable to have: a dermato-venereologist, a medical and patronage nurse, a medical registrar, two disinfectors and a nurse. If necessary, mobile scabiozoria with a disinfection chamber on the chassis can be created. The staff of such a scabiozoria should include a dermato-venereologist, a nurse, a disinstructor, a disinfector, and a nurse.

For a clear organization of the work of the scabiozoria, the examined persons are registered (last name, first name, patronymic, gender, place of study, work, position, home address, number of contact persons, name of the medical institution that sent the patient).

Patients are treated on an inpatient basis when clinical and epidemic indications require it (common, complicated forms, scabies, the inability to isolate the patient from other family members, living in a hostel, asocial persons, etc.).

It is necessary to carry out medical control of cure 3 days after the end of treatment and then every 10 days for 1.5 months.

Of great importance in the epidemiological plan is the identification, examination and monitoring of all persons who have been in contact with patients. This work should be characterized by consistency and continuity. Persons who have been in contact with patients with scabies should be examined every 10 days for 1.5 months.

As the experience of past years has shown, prophylactic treatment of all contacts has an important role in organizing the fight against scabies. The issue of preventive treatment of persons who have been in contact with patients with scabies should be addressed differentially, taking into account the epidemiological situation. Those who were in sexual and close household contact with the sick person (used his clothes, sanitary and hygienic items, bedding, shared bedding, etc.) are involved in the specified treatment, as well as entire groups, classes (kindergartens , nurseries, schools, educational institutions, etc.), where several cases of scabies are registered or, if fresh cases of scabies are detected there during the monitoring of the outbreak. The contingent of those treated prophylactically can expand in case of an unfavorable epidemiological situation. In the case of treating a patient with scabies at home, the attending physician organizes the current disinfection, which is performed by the patient himself or by a family member caring for him. The attending physician (middle medical worker) is obliged to give clear recommendations on the current disinfection, which is an important point in the fight against the spread of scabies.

Each patient must have a separate bed, bedding and personal items (washcloth, towel, etc.).

Disinfection of bedding, towels, underwear is carried out by boiling in a 1-2% soda solution or any washing powder for 5-10 minutes from the moment of boiling. Outerwear (dresses, suits, trousers, jumpers, etc.) are ironed on both sides with a hot iron, paying attention to pockets. Some items (cloaks, coats, fur coats, leather goods, suede, etc.) can be decontaminated by hanging outdoors for 5 days. When disinfecting some things (soft toys, shoes, outerwear), you can use their temporary exclusion from use for 5-7 days, placing them in a separate plastic bag.

In the patient's room, wet cleaning of the room is carried out daily with 1-2% soap and soda solution, including washing the floor, wiping the furnishings. Cleaning material after use is immersed in a disinfectant solution, hands are thoroughly washed with soap and water.

The current disinfection of the premises in scabiozoria, hospitals, isolation wards is carried out by paramedical personnel in the same order and sequence. Underwear, clothes, shoes taken from the patient are subjected to chamber treatment. After the end of the treatment of the patient, the mattresses, pillows, blankets that he used should also be subjected to chamber disinfection.

The final disinfection is carried out by the employees of the SES decontamination departments in the foci of scabies after the patient is hospitalized or at the end of outpatient treatment and the mandatory examination of all contact persons. In the case of isolation of a patient in a hostel or a children's team (nurseries, kindergartens, boarding schools, boarding houses, etc.), final disinfection is carried out twice: after identifying the patient - in the whole group, after his treatment - in the isolation ward.

Measures taken to combat scabies of the sanitary and epidemiological service

The Sanitary and Epidemiological Service carries out its measures to combat scabies in close contact with the territorial dermatovenerological institutions.

The main tasks of SES (sanitary epidemiological departments of district hospitals) are:

1) epidemiological observation of scabies foci registered in organized groups for 1.5 months;

2) control over the quality of preventive examinations of the population to detect scabies, especially among children, adolescents and decreed contingents;

3) control over the completeness and timeliness of involving in the examination of all persons who have been in contact with a patient with scabies;

4) monitoring the quality of current disinfection in outbreaks and scabiozoria; preventive disinfection in baths, showers, hairdressers, laundries and other public utilities, as well as sports and tourist equipment (sleeping bags, tents, etc.) for rent;

5) control over compliance with sanitary and hygienic and anti-epidemic rules in medical and preventive, children's institutions, schools, vocational schools, higher and secondary educational institutions, hostels, industrial enterprises, railway and water transport, public utilities, etc. ;

6) organization of the final disinfection in all foci of scabies. Final disinfection is carried out in cities no later than 6 hours after receiving notification of the need for it, and in rural areas - no later than 12 hours.

In case of violation of the sanitary-hygienic and anti-epidemic regime in the above institutions, SES employees send a summons to their leaders to provide an explanation in the form 313 / y, after which a protocol is drawn up on existing violations in the form 309 / y.

The final disinfection is carried out in accordance with the rules approved by the Main Sanitary Directorate of the USSR Ministry of Health.

In each administrative territory (republic, crane, region, city, district), according to epidemiological indications, a comprehensive plan is drawn up to combat scabies.